Erin Trieb for NBC News

Monica Velez, pictured in Austin, Texas, had two brothers, Jose "Freddy" Velez and Andrew Velez, both of whom served the U.S. military and both are now dead -- Freddy was killed in action in Iraq, and Andrew took his own life.

Before Army Spc. Andrew Velez left Texas for the final time, he asked his fragile sister to write him a promise – a vow he could carry with him to Afghanistan.

Monica Velez knew she owed him that much. In the horrid weeks after each had lost their beloved brother, Freddy Velez, to enemy fire in Iraq, Monica tried to end her life with pills and alcohol. Now, she put pen to paper: “I will not hurt myself. I will not do anything crazy. I know that Andrew loves me. I know that Freddy loved me.” Andrew folded her note and slipped it into his pocket.

“Don’t break your word to me,” he told her before heading back to war.

Seven months later, Andrew, 22, sat alone in an Army office at a base in Afghanistan. He put a gun to his head and committed suicide. Back in Texas, word reached Monica Velez who, once again, found herself in a dangerous place. Only now, she was alone. Days of alcohol and anti-depressants. Nights of dark thoughts: “It would just be better if I was gone.”

'The storm' is coming
As the U.S. military suicide rate soared to record heights during 2012, the families of service members say they, too, are witnessing a silent wave of self-harm occurring within their civilian ranks: spouses, children, parents and siblings. 

Some suicides and suicide attempts — like those that ravaged the Velez family — are spurred by combat losses.

Others may be triggered by exhaustion and despair: As some veterans return debilitated by anxiety, many spouses realize it's now up to them — and will be for decades — to hold the family together.

Specific figures are lacking as no agency tracks civilian suicides within military families.

However, Kristina Kaufmann, a long-time Army wife, knows of three other Army wives, all friends, who took their lives in recent years.

Courtesy Kristina Kaufmann

"When you know that you are the anchor — and if you go down, the family's going down — the problem is that you can only do that for so long," said Kristina Kaufmann.

One was Faye Vick, described by Kaufmann as “the perfect picture of an Army wife — pretty, nice, always with a smile.” Vick and her family lived around the corner from Kaufmann and near Fort Bragg, N.C. In 2006, when Kaufmann’s husband was in Afghanistan and Vick’s husband was deployed overseas, the 39-year-old mother placed herself, her infant and her 2-year-old son in a car inside a closed garage and started the engine, asphyxiating all three with carbon monoxide, according to Kaufmann and to local news reports at the time.

“And I know of too many others through the grapevine,” said Kaufmann, executive director of Code of Support, an Alexandria, Va.-based nonprofit that seeks to bridge the gap between civilians and military America.

“When you know that you are the anchor — and if you go down, the family’s going down — the problem is that you can only do that for so long,” said Kaufmann. “That population (of spouses) is at the most risk. Because the storm is going to happen when everybody comes home. That’s where we are, unfortunately, going to see an uptick in lots of negative outcomes, including suicide, including suicide among the spouses.”

On Jan. 14, Department of Defense officials acknowledged that during 2012, service members committed suicide at a record pace as more than 349 people took their own lives across the four branches. The military suicide rate is slightly lower than that of the general public. However, one active-duty member died by suicide every 25 hours last year. 

The Army sustained the heaviest branch toll at 182 suicides, which — as NBC News reported Jan. 3 — meant that soldier suicides outpaced combat deaths for the first time, according to Pentagon officials.

Defense Secretary Leon Panetta informed Congress last July that American armed forces are in the grip of a suicide "epidemic." 

One of the darkest undercurrents of the glaring statistics is that one suicide in a family boosts future suicide risks for everyone else inside the home. They can be contagious, say experts like Dr. Barbara Van Dahlen, a psychologist in the Washington, D.C., area and the founder of Give an Hour, which develops networks of mental-health volunteers who respond to both acute and chronic situations.

Numerous researchers have explored the so-called contagion effect of suicides within families and “there’s no question the data supports there’s at least a doubling of risk,” among surviving family members, said Dr. Alan L. Berman, Ph.D., executive director of the American Association of Suicidology. The organization strives to better understand and prevent suicide.

“It’s understood that risk, in part, is biological," Berman said, given that disorders like depression have a genetic component. 

“But it’s also based on social modeling behavior: The suicide of a parent presents a model (for children in that family) of how to deal with problems, and that’s no less true for a spouse.”

Added Van Dahlen: "The closer that family member is to you, the greater risk you’re at. We believe, psychologically, it opens the possibility and ends a taboo."

“The thousands of service members who have killed themselves,” she added, “they leave in their wake thousands of family members who are now at risk for that same kind of decision."

'I completely lost myself'
The cascade of Velez family tragedies began with pure valor.

On Nov. 13, 2004, Army Cpl. Jose “Freddy” Velez, 23, sprayed bullets at insurgent forces — covering fire to allow other U.S. soldiers time to retreat from an enemy strong point in Fallujah, Iraq. After his ammo ran dry, Freddy Velez was shot and killed. The Army awarded him the Bronze Star and Silver Star.

Courtesy Monica Velez

"There are days I'm still overwhelmed. And if I sit and think about it, I feel like I wouldn't have to live through all this pain if I just let myself go," said Monica Velez, who shared family photos of brothers Freddy and Andrew.

Andrew, then serving with another unit in Iraq, told Monica of escorting his brother’s body home to Lubbock, Texas — a job, he said, that required unzipping his brother’s body bag at every stop to re-verify Freddy’s identity.

During the trip, Andrew called his sister repeatedly while en route home and screamed into the phone for nearly two consecutive hours, “like somebody was killing him,” she said.

“There was nothing I could do,” Monica Velez recalled. “The operator kept cutting in (to request additional payment for the call) and I just said, ‘Add it to my credit card.’ He just wailed. That travel home, I think is what eventually broke him.”

Weeks later, Monica broke.

She doesn’t know how close she came to death the first time she tried to end her life. She never was told how slow her pulse became that night. She just remembers regaining consciousness at a hospital in Killeen, Texas — home to Fort Hood, where Freddy was based. She awoke with an IV plugged into her arm. A doctor handed her a list of local psychiatrists then discharged her.

Velez tried, she said, to seek help for her deepening depression but was told that her health insurance would not cover counseling.

Her grief was rooted in a difficult childhood, she said, that forged "tighter than tight" emotional bonds between Velez and her two brothers, turning the siblings into a mutual support group.

“When Freddy passed away, I went through a really hard depression,” she said. “I went to the emergency room for anxiety attacks. I couldn’t breathe. But nobody knew how to deal with me so they just gave me Ativan (an anti-anxiety drug) and Hydrocodone (a pain killer).

“I started drinking heavily and taking the prescriptions. And one day, I just felt it would be better off if I wasn’t around and decided to take all of the pills. Grief can bring you to that breaking moment.”

Soon after, in February 2005, Andrew sent his older sister (then 25) an email: “We need to be stronger. We need to protect each other.”

Though he was the youngest of the siblings, Andrew always was “the strong one,” his sister said. “But he and Freddy were inseparable.” Near the end of 2005, Andrew told his sister he was redeploying to Afghanistan because, she said, “I think he felt closer to Freddy there.”

From March through July of 2006, the two swapped calls and emails. In Afghanistan, Andrew grew increasingly despondent, she said, over the unraveling of his marriage and family in Lubbock. He had three children. But he worried, too, about his sister’s state of mind.

“We could both hear it in each other’s voices. He was scared I was going to do something. I was scared he was going to do something.”

He did. Andrew’s suicide on July 25, 2006, drove Monica, at first, into 20-hour workdays at a domestic violence shelter. She wasn’t sleeping or eating. Eventually, she was drinking again, “from the morning until I passed out,” she said. “Then, doing it again the next day.

“I completely lost myself. I resigned my job. I stopped paying my bills. I got evicted. I was prescribed anti-depressants. I noticed taking the pills and drinking got me out of the emotions. So I found myself in a dangerous place very quickly.

“Again — several trips to the ER (for overdoses). I’m not sure why I wasn’t ever held there. In my down periods, I would tell myself it would just be better off if I was gone.”

In 2008, a friend at Fort Hood, Texas, connected Velez with the Tragedy Assistance Program For Survivors (TAPS), a resource for anyone who suffers the loss of a military loved one.

“That was the first time anybody had offered to help me with the depression and the grief.” she said.

'Family units breaking down'
Kaufmann, who lost three Army-spouse friends to suicide, argues that military-family suicides should be tracked and researched by the Department of Defense to help mental-health experts begin to slow or stop the problem. She knows, however, such an accounting is not likely. 

“I get the sense that people in the military think that by including families into this kind of discussion — particularly when you’re talking about the (broader) mental-health impacts on family members — they look at that as something that will only add to the problem. Whereas, we believe that it would prove to be a solution,” Kauffman said.

“We’ve approached this very myopically. More than half of soldiers are married. Soldiers come with families. And the military has a maddening way of both dismissing families and holding them accountable at the same time. It’s frustrating for us, not only when we’re trying to get our husbands help, but also when you have the family units breaking down,” she added. 

NBC News requested to speak with officials at the newly formed Department of Defense suicide-prevention office about the issue of suicides within military families and whether tracking is needed. A DOD spokeswoman said, however, that the office is only working to address active-duty suicides. The interview request was not granted.

Van Dahlen, meanwhile, believes that asking DOD to track military families is an unreasonable expectation to place on the agency when it already is facing budget cuts.

Even if the DOD wants to — and many of my colleagues there desperately would want to devote resources to this — those resources are not going to be there,” she said. Rather than putting "the screws to DOD" and doing "even more with even less," Van Dahlen believes public-private partnerships should be encouraged "to figure out how we can (address) this together."

'Like an airborne disease'
More than eight years after Freddy’s combat death, and more than six years removed from Andrew’s suicide, Monica Velez annually runs the Marine Corps Marathon in Washington, D.C., in honor of her fallen brothers.

Matt Slocum / AP file

Monica Velez cleans her brother's name, engraved in a memorial at Fort Hood, Texas.

But, now living in Austin, she acknowledges she still struggles with what she calls, “those thoughts.”

“There are days I’m still overwhelmed. And if I sit and think about it, I feel like I wouldn’t have to live through all this pain if I just let myself go. It doesn’t just go away. But you learn how to cope. You learn better coping skills,” she said, adding she gained those tools from TAPS.

Army officers at Fort Hood have occasionally asked her, she said, for ideas to help them prevent the rising military suicide rate. She watches that tally, too.

“The numbers take my breath away. I know it can be overwhelming for the Army generals on the other end of the table trying to figure this problem out. Because it’s like an airborne disease going through the building and you’re trying to figure out how to stop it before it gets to you," she said. 

“But it’s coming at a really fast rate, and it’s inevitable.”

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More soldiers took their own lives than died in combat during 2012, new Department of Defense figures show. The Army's suicide rate has climbed by 9 percent since the military branch launched its suicide-prevention campaign in 2009.

Through November, 177 active-duty soldiers had committed suicide compared to 165 during all of 2011 and 156 in 2010. In all of 2012, 176 soldiers were killed in action -- all while serving in Operation Enduring Freedom, according to DOD.

Army suicides have increased by at least 54 percent since 2007 when there were 115 — a number the Washington Post then called "an all-time record." An Army spokesman said Wednesday it is uncertain if 177 marks a new annual high (with December numbers still to come), or if suicides have ever outpaced combat deaths in a single year, because the Army has not always tracked suicides.

Some Army families who recently lost members to suicide criticize the branch for failing to aggressively shake a culture in which soldiers believe they'll be deemed weak and denied promotion if they seek mental health aid. They also blame Army leaders for focusing more heavily on weeding out  emotionally troubled soldiers to artificially suppress the branch's suicide stats versus embracing and helping members who are exhibiting clear signs of trouble.

Furthermore, in September, two U.S. lawmakers pressured the Pentagon to immediately use unspent money specifically appropriated to the agency to help slow the suicides within the military. Rep. Jim McDermott, D-Wash., and Rep. Leonard Boswell, D-Iowa, also pushed for increased anti-suicide funding for the Department of Defense in 2013.

“The Pentagon hasn’t spent the money that it has for suicide prevention for this year — and that money wasn’t nearly enough money to reach all the soldiers who need help. Now we are hearing about bureaucratic technicalities at the Pentagon that are preventing them from acting. This is unconscionable,” Rep. McDermott said. “The Pentagon is funded to help soldiers and needs to do much more on the epidemic of suicides."  

But the Department of Defense contends that anti-suicide programs installed throughout the armed services soon will curb military suicides — and that such initiatives already have helped douse mental-health stigmas.

"We have seen several programs that we are optimistic are going to start making a dent in this issue," said Jackie Garrick, acting director of the DOD suicide prevention office. "We’ve asked all of the services to use the same messaging, the same talking points. So the Army, included in that, is trying to adapt and promote those same messages because we realize that this is an across-the-board problem."

The Army could not provide a suicide-prevention officer to comment, but an Army spokeswoman did forward NBC News a link to the “Army Suicide Prevention Program.”

Within that initiative, soldiers are taught to “Ask, Care, and Escort” any Army buddy who mentions considering suicide, to usher them to behavioral-health provider, chaplain, or a primary-care provider, and to “never leave your friend alone." The U.S. military also installed a prevention “lifeline:” 1-800-273-TALK.

What's more, soldiers are assured that seeking mental-health counseling will not harm their chances at gaining a security clearance. And on that website, a video shows Sgt. Maj. Raymond F. Chandler III, the Army's top non-commissioned officer, speaking to other NCOs: “Know your soldiers. Know the resources available to them when they are in crisis ... Encourage your soldiers to seek help ... Seeking help is a sign of courage.”

The anti-suicide strategy was rolled out in April 2009 by Army Vice Chief of Staff Gen. Peter W. Chiarelli.

In July 2010, the Army released a report that sought to explain its suicide epidemic. Some Army families were irked by one of the key findings: Loosened recruitment and retention standards — due to the furious pace of repeated deployments — had allowed more than 47,000 people to remain in the Army despite histories of substance abuse, misdemeanor crime or “serious misconduct.”

Chiarelli further frustrated many Army families who had lost members to suicide when, amid the release of that same report, he added: “I think it’s fair to say in some instances it would be a soldier that’s possibly married, couple of kids, lost his job, no health care insurance, possibly a single parent.” Those types of soldiers, he added, are “coming in the Army to start all over again, and we see this high rate of suicide.”

Two days before Charielli’s comments, 28-year-old Army soldier Brandon Barrett showed up at his parents' home in Tucson, Ariz. The family believed he was on leave following a brutal, year-long deployment in Afghanistan with the 5th Stryker Brigade during which he saw several buddies killed or wounded by bombs and did some killing himself.

During that visit, Barrett’s family thought his Army experience seemed to be helping him to mature, recalls his brother, Shane Barrett, a detective with the Tucson Police Department.

In August, Brandon Barrett left his parents’ home and drove — for unknown reasons — to Salt Lake City where he donned his combat fatigues, boots and helmet, grabbed his AR-15 rifle, went to a hotel and told an employee to call the police. As he waited for the officers, Barrett paced the hotel parking lot as if he was on patrol, a hotel video showed. A police officer arrived. Barrett shot him in the leg. The officer returned fire and killed Barrett with a bullet to the head. His family believes Barrett intended to commit “suicide by cop,” his brother acknowledged. 

Courtesy Barrett family

Brandon Barrett confided to a chaplain within his unit, the Barrett family learned since his death, revealing that his year of combat in Afghanistan had left him depressed and anxious.

“He’d been home for nearly a month,” Shane Barrett told NBC News. “We had no contact from anybody in the Army until my brother’s incident. And then, after the fact, it was: ‘Your brother was AWOL (absent without leave).’ Really? We didn’t know that.

“If a guy goes AWOL, the Army is supposed to notify the family immediately. We never received phone calls, letters. We were blindsided. At the police department where I work, they ran all kinds of record checks on him. But they found absolutely nothing (about an AWOL report).

“My mother has always believed he was declared AWOL after the fact just so the Army could get him off the rolls and not have his suicide count against the Army,” Shane Barrett said. “To just discard him, like he never existed, is just wrong. And there’s no paper trail, no nothing to back up the AWOL claim.”

The Barrett family later learned that Brandon had confided to a chaplain within his unit, revealing that his year of combat in Afghanistan had left him depressed and anxious. And possibly mulling suicide.

“From talking to a couple of other guys in his unit, he didn’t want to come forward (to seek mental-health help) because you’d be red-flagged. It would be your exit out of the Army,” Shane Barrett said. “The guys in the Army are just flat-out afraid to come forward.”

At the Department of Defense, anti-suicide chief Garrick was asked if the Army is indeed clinging to a culture of “suck it up" and handle your own problems,” as some Army families contend.

“No, I think all of the services have done a pretty good job of trying to get a message out. The Army ... they’ve done the 'shoulder-to-shoulder,' (approach, and have said) ‘no soldier stands alone.' That’s been some of their messaging, now going back a while,” Garrick said.

“The Secretary of Defense (Leon Panetta), this past year, issued a statement talking about how our service members are our most valuable resource and that we need to do everything we can to take care of our people. So we’re doing everything we can to prevent suicides in the military, recognizing that it’s a complex and urgent problem.”

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Courtesy of Rebecca Morrison

Ian Morrison and Rebecca Morrison, taken at Fort Hood in Texas the day he deployed to Iraq as an Army Apache helicopter pilot. He flew 70 missions in Iraq. In March this year, Ian Morrison committed suicide in Texas at age 26.

The call she placed, and the advice she received, didn’t simply allow Rebecca Morrison to survive one of her worst days. The words she heard, she said, saved her life.

Before a Fort Hood memorial service to honor her husband – an Army chopper pilot who ended his life – Morrison grabbed a scrap of paper from her nightstand, read the scrawled number, and dialed up the Tragedy Assistance Program for Survivors (TAPS). In that pitch-black moment, she needed answers to two desperate questions. On the other end, Kim Ruocco listened. Seven years earlier, Ruocco had lost her husband, a Marine major, to suicide.

“I can’t even breathe,” Morrison began, through sobs, from her Texas home. “How do you breathe?”

“It will just come,” Ruocco replied from the TAPS office in Arlington, Va.

“How can I ever be happy again?”

“It doesn’t get less painful,” Ruocco told her. “After time, it just gets ... less present.”

Six months later, Morrison, 25, is breathing. She’s also teaching third graders, running, riding her horse, and — Thursday — remembering Ian on what would have been his 27th birthday. She's also speaking at anti-suicide events and launching a suicide support group near Dallas — all of it, she added, because she placed that call. But with one U.S. service member committing suicide every 19 hours, it’s the breathing that Morrison mentions first when asked how TAPS helped her most.

“Once you lose someone to suicide, you are so prone to suicide yourself. I got to that point. If they hadn’t been there, I wouldn’t be here,” she said. “Every widow I’ve talked to, every family member, has felt that way. You just want to be with that person more than anything. I mean, he was my husband. They’re saving the lives of the survivors.”

The suicide crisis inside the military has, indeed, injected fresh urgency into the larger mission of TAPS, a peer-based, emotional support group for families who have lost active-duty military members overseas or at home. It also has “stretched” the nonprofit’s budget and 53-member staff, said Bonnie Carroll, who founded TAPS in 1994 after her husband, Brigadier General Tom Carroll, was killed in a plane crash.

Courtesy of Bonnie Carroll

Bonnie Carroll founded TAPS in 1994, two years after her Army husband, Tom, was killed in a plane crash. When Rebecca Morrison called TAPS last April, Bonnie answered the phone.

“We are the alumni association for those who have died in the military. There is no one else that does this,” Carroll said. “Whether it’s a motorcycle crash or a death in combat or a suicide, for the family, it’s the same knock on the door, the same folded flag.

“We’re seeing an increase in the death rate, in the casualty rate, but from the public’s perception: ‘Oh, the war is over and everybody’s home and they’re safe.’ Well, in a skewed way it almost seems like you’re safer in a deployed environment. You’re less likely to die there of a hostile attack than you are to die here.”

Some increasingly sad statistics: During the first nine months of this year, 247 Army troops — including active-duty soldiers, National Guard members and reservists, have committed suicide, according to a Department of Defense report last week. (The Army is the only military branch that issues monthly press statements on suicides). In 2012, the Army suicide rate has climbed over last year, despite myriad anti-suicide initiatives, conferences and medical studies as well as prevention promises and get-help pleas both inside and outside the branch. Meanwhile, within the Navy, Marines and Air Force, another 126 service members combined have taken their lives this year, reports ArmyTimes. 

As America transitions from a decade of war toward a hopeful peace, TAPS has rarely been busier. The organization, which staffs a 24-hour hotline, is fielding, on average, 111 calls per day, Carroll said. From November 2011 through this past September, TAPS began working with 4,138 new survivors.

In the military community, the TAPS team is considered credible, Carroll said, because each member has lived that moment.

“The traumatic death of an immediate loved one will knock you out and sometimes kill you. You really need to deal with it on a very deep and serious level,” Carroll said. “And the absolute best support — what we’re really finding with our suicide survivors — is that unless they’re talking with another mom found her son after he died by suicide, they’re just not going to talk.”

As its staff now connects, on average, with 376 new survivors per day, TAPS is feeling the urgent need “to definitely do more,” Carroll said.

But on an already-tight budget, seeking extra dollars to meet the crisis requires a delicate, high wire walk worthy of a Wallenda: A nonprofit must project fiscal stability while also demonstrating its growing obligation.

“After 9/11, why did people continue to give to the Red Cross even though it was funded in the billions? It’s because people give to organizations that are financially sound. Which is counterintuitive. You’d think they’d give to the ones that have a more desperate need for the funding,” Carroll said. “So it’s a really tough balance there. We are financially sound. We take every penny and put it toward appropriate programs. We have wonderful partners. But we are constantly searching to meet that need.”

TAPS spends $450,000 per month, Carroll said. In addition to its paid staff and the 24-hour hotline they manage, the group publishes a quarterly magazine and stages dozens of survivor events around the country, including a conference for military-suicide survivors earlier this month in San Diego.

Funding is funneled to the nonprofit from neighborhood bake sales on to large checks from corporate partners, including foundations affiliated with Prudential, New York Life and Hasbro.

“There is no membership — no fees, no dues,” Carroll said. “The cost of admission is the sacrifice of a loved one. And the care they receive is forever and always.”

TAPS further squeezes its budget by leveraging a 1,000-plus legion of volunteers — survivors who are, themselves, at least two years beyond their own loss and trained in how to support the newly bereaved. That network is the bittersweet result of the mounting losses on the home front: as more service members die after returning from war, more of their survivors are volunteering with TAPS.

“That is the holy grail of why this works. It’s a concept of: when you help another person, you continue your own healing,” Carroll said.

Courtesy of Bonnie Carroll

Bonnie and Tom Carroll. They met in Alaska in 1988 during a massive attempt to save three gray whales trapped beneath pack ice.

This is the sacred notion that inspired Carroll to build TAPS. While working for the Reagan White House, she met her Army husband, Tom, on a massive spread of pack ice in Barrow, Alaska, in 1988 amid a globally watched effort — dubbed “Operation Breakthrough” — to free three trapped gray whales. That rescue inspired the 2012 film "Big Miracle."

Tom, portrayed by Dermot Mulroney, and Bonnie, portrayed by Vinessa Shaw, later married. Their wedding — complete with a cake topped by icing-laden whale replicas — was re-enacted in the film. (Their characters had different names in the movie — a choice made by the filmmakers because “Big Miracle” is not a documentary).

“That’s Tom, that’s us. He’s that guy, and I’m that White House girl,” Carroll said.

Four years after the whale rescue, Tom Carroll died along with eight other soldiers in an Army C-12 plane crash in Alaska.

“When Tom was killed, that was my family. Now I have this extraordinary family of tens of thousands of incredible Americans who have made the ultimate sacrifice for this nation’s freedom,” Bonnie Carroll said. “We’re a family healing together."

Courtesy of Rebecca Morrison

Last weekend, Rebecca Morrison ran the Army Ten-Miler in Washington, D.C. to help raise money and awareness for TAPS - and as part of her own healing following the loss of her husband.

Now, Rebecca Morrison wants to join that family.

With a degree in counseling and the life experience of a survivor, she’s hoping to eventually work with TAPS.

In the meantime, she already has become closely aligned with the nonprofit. On Oct. 21, she ran in the Army Ten Miler — which started and finished at the Pentagon — and helped raise money for TAPS. In June, she spoke as part of a TAPS survivor panel during the annual Department of Defense/Department of Veterans Affairs Suicide Prevention Conference in Washington, D.C. And in July, Kim Ruocco of TAPS asked Morison to share her raw story for a Time magazine cover piece on military suicides titled “One A Day.”

“For me to feel better about this, I have to help other people,” Morrison said.

“Bonnie, Kim and everybody made that possible. Through speaking out, I have been able to heal.”

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The Department of Defense is hoping that two new weapons – big money and little oil – can curb the rising military suicide rate.

A three-year, $10 million study, to be funded by the Department of Defense and conducted at the Medical University of South Carolina, will test whether omega-3 fatty acids found in fish oils can relieve the anxieties and quiet the suicidal thoughts plaguing many combat veterans, one of the lead researchers said Monday.

Scientists at the National Institutes of Health have long maintained that a diet heavy in omega-3 – common in salmon, anchovies and other oily fish – can elevate happiness.

“The problem is coming to a head with the recognition that in the military, you’re more likely to die by suicide than by enemy combatant – and that’s not acceptable,” said Dr. Ron Acierno, a co-investigator on the project and a professor in the department of psychiatry at the Medical University of South Carolina in Charleston, S.C.

“Omega-3s are among the primary fatty acids in the brain. They cannot be synthesized by the body – which means they have to be eaten (via food, drink or pill form). They’re responsible for neural generation and neural repair – for new neurons to be made and for broken ones to be fixed,” added Acierno, who also serves as the director of the PTSD clinical team at the Ralph H. Johnson VA Medical Center in Charleston.

The participants are veterans or service members who have been referred to a VA mental health treatment program because they are having suicidal thoughts. If the patients agree to join the study, they will be secretly placed in one of two groups. One segment will drink juice-box-sized smoothies high in omega-3. The second will drink placebos.

“Anybody who is showing suicidal ideation is going to be referred for the standard mental health treatment at the VA here in Charleston, which is a best practices site, so the standard treatment here is pretty good,” Acierno said. That means, he added, that military folks in the placebo group will not receive inadequate care. 

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For those former and current service members who receive the omega-3-laced smoothies, they’ll be asked to gulp one in the morning and another at night. All of the study participants then will be tracked over time as researchers interview them and measure, via a scoring system, their suicidal thoughts and intentions – whether they have formed a plan to take their own lives – along with their anxiety levels and cognitive-processing abilities, Acierno said. Any actual attempts by the participants to harm themselves will be immediately treated but that bahavior will become part of the study’s data.

In addition to medical literature accounts that show omega-3 can buoy mental health, the study team is “excited” about the prospects of fish oil serving as something of a solution, Acierno said, because the product carries an “extremely low risk” for side effects. It's also relatively cheap – costing between $12 and $35 retail.

At Target, for example, a bottle of Nature Made Ultra Omega-3 Fish Oil, priced at $11.89, holds 45 softgel pills each containing 1,400 milligrams. Target also sells $44.99 boxes of Coromega orange-flavored squeeze packets that each contain 650 milligrams of omega-3, derived from pharmaceutical-grade fish oil. 

“The potential good versus the potential extraordinarily low risk and low cost make this a type of intervention that can be – if findings are warranted – rolled out extremely fast and on a large scale,” Acierno said.

Bonnie Carroll, a leading expert in military suicides and founder and president of the Tragedy Assistance Program for Survivors (TAPS),  said she has not read or heard about omega-3 as a possible medicinal tool in treating depression or post-traumatic stress. 

"We are very open-minded on any techniques that might be useful," said Carroll, whose organization provides peer-based emotional support for families affected by the death of a loved one serving in the U.S. military. She also was co-chair of the DOD Task Force on the Prevention of Suicide in the Armed Forces. 

Omega-3 has been on under the microscope for more than a year as experts have tried to dissect the high number of military suicides. In August 2011, a study published in the Journal of Clinical Psychiatry suggested that certain fish oil components had potent psychiatric benefits and suggested that taking an omega-3 supplement might help service members. That research, performed in part by the Uniformed Services University of Health Sciences, scanned through the medical records of 800 U.S. service members who took their own lives between 2002 and 2008, comparing those against the health files of 800 active-duty personnel who had not attempted suicide. The scientists found that service members with higher blood amounts of docosahexaenoic acid - an omega-3 fatty acid - were less likely to take their own lives.

Should veterans who have considered suicide begin swallowing omega-3 pills on their own now?

“Buying the omega-3s and taking them is not going to be a problem,” Acierno said. “However, if they do have these types of thoughts or feelings, remember that even the people in this study – even those who are on the placebo – are getting mental health care.

“So we never want to say this is a replacement for evidence-based mental health care," he added. “This is a supplement and one that is easily added. It’s also important that you get the care you need.” 

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A leading veterans group, seeking to muscle any mention of military issues into the first presidential debate, published an online voter guide Tuesday listing five criteria on which service members past and present can judge the two candidates and ultimately cast their votes. 

Iraq and Afghanistan Veterans of America, a nonpartisan and nonprofit group with more than 200,000 members, released "Vote Smart For Vets" on its website with hopes that its five stated benchmarks — along with some mathematical prodding — will prompt Republican candidate Mitt Romney and President Barack Obama to tangle on topics that include the military suicide epidemic or the high veteran unemployment rate. 

"Our goal is to obviously make progress on these issues but also just to get the candidates talking about them," said Paul Rieckhoff, chief executive officer and founder of IAVA. "We get a lot of pandering. We get a lot of pleasantries. We get a lot of ceremony. But let’s get down to specifics.

"We’re trying to force just a conversation of any kind (about veterans) when economic issues are front and center," added Rieckhoff, who served as a first lieutenant and infantry rifle platoon leader in Iraq during 2003 and 2004. 

The five-point checklist drafted by the IAVA for veterans and vet-friendly voters "to evaluate your candidates' platforms" is placed in this order:  

• Ensuring Iraq and Afghanistan veterans have the tools they need to succeed in the civilian work force;
• Ensuring every veteran has the right to the education benefits they have earned;
• Improving mental health programs in the military and VA to prevent further suicides among troops and veterans;
• Modernizing the claims process at the VA so that veterans have access to the benefits and resources they have earned;
• Improving VA healthcare facilities and claims processes for female veterans. 

How have Romney and Obama fared — in the eyes of veterans — in their attention to or work on those five points? 

"The reality is that neither one has been judged on them yet because these issues really haven’t been a focal point in the campaign," Rieckhoff said. "You’re not hearing about plans to lower veteran unemployment."

Related: NBC/WSJ poll: Obama holds lead over Romney in key battleground Ohio

Partly due to the lagging U.S. economy, joblessness has dogged thousands of men and women who have returned after serving in Iraq and Afghanistan. During 2011, the veteran unemployment rate was more than 12 percent — far above the national median. In August of this year, that number was 10.9 percent — still higher than the rest of the American work force. 

"We view this as not just a social issue but an opportunity for investment. If you invest in these men and women coming home it’s going to produce a tremendous return," Rieckhoff said. "This is might be the one thing  Romney and Obama could agree about on the stage. But we’ve got to force the questions.

"Just one question about veterans during the debate makes everybody remember that we’re out there," he added. 

If either campaign needs more convincing that winning the military and veterans vote could tip the election, IAVA is armed with the sorts of stats that make pollsters drool. 

More than 2.4 million veterans have served in Iraq and Afghanistan. Three battleground states are packed with veterans: 60,000-plus in Ohio, and more than 150,000 in both Virginia and Florida. The organization also reports that 90 percent of new veterans are registered to vote, and many remain undecided.

In fact, according to a membership survey IAVA conducted last year, more than 40 the group's participants don't identify themselves as Republicans or Democrats.

"If you look at the broader military and veterans population, that’s an incredibly influential voting bloc. And not only are they strong in numbers and not only are they registered to vote in a high percentage, they’re also very influential," Rieckhoff said. "They have an opportunity to be force multipliers — not only influencing their families but influencing their communities.

"They're also incredibly nonpartisan," he added. "They’re patriotic and pragmatic and they just want to see people who can get things done. They are much more dedicated to their country than they are their party. They are a political jump ball."

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Everything you see in the music video happened to Marine-turned-country-singer Stephen Cochran: Pushing the girl away, boozing into oblivion, the gun on the blanket. It all went down last year. 

Courtesy of Stephen Cochran

Stephen Cochran, a former Marine recon scout and now a country-music singer, has penned a new song about PTSD - combat-related symptoms that almost claimed his life in 2011.

Even the actor who portrays Cochran is, himself, a former Marine and Iraq veteran who knows of post-traumatic stress, who has wrangled with identical demons. The actor was not acting.

The only on-screen tweak from reality was the type firearm shown. In his dimmest hour, behind a locked door in his Nashville home, exhausted, alone, and telling himself: “I’m done,” Cochran rested a loaded shotgun against his bed.

“I was just trying to get the nerve. I had it planned out,” Cochran told NBC News. “I didn’t know what was wrong with me. I was tired of taking all these pills. I was going through a breakup. Couldn’t write anymore. Watching everything fall apart. I was ready to check out.”

Then: salvation, and a surreal rescue scene worthy of an epic ballad. His dog, Semper Fi, began scratching relentlessly at his door, bloodying her paws. Next, Cochran’s ex-fiancé unexpectedly entered the house, simply to retrieve a forgotten item, he said. She saw the anxious dog. She expected the worst. She barged into the bedroom, spotted the gun and physically restrained Cochran. 

But from anguish came inspiration. Amid an existence long blurred by PTSD — the residue of Afghanistan firefights, Marine buddies lost in combat, and his own nearly fatal injury — one question blazed in Cochran's head. He jotted it down: “How do you paint a picture back in focus?”

“It was the only way I could describe trying to put your life back together, literally trying to do the impossible,” he said.

Around that single thought, Cochran penned an entire song, “Pieces,”an ode to the blackness from which he was aching to escape, a tale of reconnecting the scattered fragments of his shattered world, and a message of solidarity for his military brothers and sisters. The single — part of a CD with the same title — will be released in this country on Nov. 11. The song already has charted in Europe.

“It’s not just my story. So many of us think about (suicide) because you just get so tired, so tired of being the crazy guy. Or of hearing: ‘He’s weird.’ Or of hearing: ‘We can’t hire you because we really don’t know what post-traumatic stress is and you might come back and kill us all.’

“I really wrote it as my own healing, for what I was going through,” added Cochran, 33, who teamed with fellow musician Trevor Rosen to complete the song. It took them only 15 minutes.

But after playing it at several veterans’ benefits, Cochran heard from service members up and down the chain of command how they, too, connected with the lyrics. That feedback has turned “Pieces” into the soundtrack of the singer’s ongoing crusade.

“We have an epidemic of suicides in the military right now. At this point, we are physically losing both of these wars in the United States of America, not overseas.

Related: First opera about Iraq War reaches out to veteran suffering from PTSD

“If we want to stop our suicides, we need a complete overhaul in our ‘warrior’ terminology in this country, in the way we train our families (how to relate with homecoming veterans). That’s what I want to start with ‘Pieces,’ and the video. I want to get a bridge between our civilian population and the veterans. And I want to reach into the rooms of some of these guys and girls — who are just sitting in the dark and watching TV all day like I did — and let them know: You’re not alone.”

Perhaps the most ironic thread of Cochran’s story coils back to the days of his first, true musical success. In 2007, one year after retiring from the Marines, he scored a country hit with “Friday Night Fireside,” the culmination of a childhood dream for a guy raised in Nashville. The accompanying video was voted No. 1 by Great American Country fans for five straight weeks.

courtesy of Stephen Cochran

After his the light-armoured vehicle crashed in Afghanistan, Stephen Cochran fractured vertebrae and suffered a traumatic brain injury in 2004. Told he would never walk again, an experimental procedure by VA surgeons restored his steps.

Two years later, Cochran became the national spokesman for research and development at the U.S. Department of Veterans Affairs — his thank you for a successful, experimental surgery performed by VA surgeons who repaired his broken back. In 2004, Cochran had splintered several lumbar vertebrae when the vehicle in which he was riding through southern Afghanistan slammed into gaping hole that once held an anti-tank mine. He couldn’t feel or move his legs for months, and was told by doctors that he’d never take steps again. He walked.

The former Marine reconnaissance scout, part of the U.S. force that first knocked the Taliban out of Afghanistan’s Helmand Province, next teamed up with the VA to become its national co-chair for voluntary service. In that role, Cochran toured America, urging veterans to seek help for combat stress, “to let them know you don’t have to suffer in silence,” recalled Rosetta Fisher-Oliver, the VA’s chief of voluntary service for Tennessee and for parts of Kentucky and Georgia.

In 2011, Cochran recorded the music video “Hope” for the VA to try and cement his get-help pleas to fellow troops. What few knew: Cochran was losing his own hope.

“We worked on that video together, and the week he was supposed to make the video, I tried to get in touch with him, just to check to see that he was going to be on time,” said Fisher-Oliver.

She was unable to reach him, however, because Cochran was by then seeking treatment — after reaching the brink of suicide in his bedroom.

“Here’s a person who’s trying to get the message out and he’s still struggling with issues too,” she said. “He later told me: ‘I almost wasn’t here.’ ”

Cochran now acknowledges that he carried “almost dual personalities” during that time. In front of fellow veterans and fans, he sang, smiled, shook hands and signed autographs. “But I also had to deal with this monster I have inside my head and inside my gut, all day.” At home, his family and his then-fiancé, he admitted, took the brunt of his mood swings and emotional detachment.

courtesy of Stephen Cochran

After breaking his back in Afghanistan, Cochran was greeted by a fellow Marine. He later regained the ability to walk.

“You’re screaming out: Please help me understand what I’m going through, because I have no clue! That’s why you see the high number of divorces in the military,” Cochran said. “I told my fiancé: ‘I don’t know what I’m dealing with so the best thing for you to do is just leave and you’ll thank me later.' ”

She left.

But in what could have been Cochran’s final minutes, she came back, and burst into his bedroom.

After Cochran artfully turned that horrid moment into a song, he met the man picked to portray his downward spiral in the “Pieces” video: Daniel Dean, a Nashville songwriter and actor. He also looks a bit like Cochran. He seemed like a logical choice.

In talking with Dean, though, Cochran learned that the man was a Marine sniper who did three tours in Iraq. And they both had lived for years with the lingering anxieties that often remain for veterans who log months of combat exposure.

“He told me: 'This is my story, too,'” Cochran remembers. “That dude lived that.”

They also agreed with the concept that “Pieces” would be not just the first music video to delve so deeply into PTSD. It would break ranks with dozens of other standard, country-music videos about the U.S. military — mini movies that often include battle scenes that, some critics say, glorify war.

“Stephen does country music and so do I, and there’s a lot of military songs and a lot of them are pretty much B.S.” Dean said. “You’ve got the Toby Keith type stuff and that’s all right for what it is. But very rarely does a song hit a military person the way this one does.

“Just because it’s real. It’s one of the things I doubt you’ll hear any of the other country stars singing about. It’s (usually) more of the patriotic angle. Most military members aren’t songwriters like Stephen and I. So, I guess that lets us be able to sing things that you can’t say or can't deal with.” 

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The military is seeing unprecedented mental illness and suicide in its ranks, and is funding research to treat depression and prevent the most tragic of outcomes.

In July, a report released by the military found that mental health disorders in active-duty troops increased 65 percent since 2000. Of the more than 900,000 diagnoses, about 85 percent included cases of adjustment disorders, depression, alcohol abuse and anxiety. This month, the Army reported 38 suspected suicides among active-duty and reserve soldiers in July, the highest monthly number of suicides since record-keeping began a few years ago. 

Col. Carl Castro, director of the Military Operational Medicine Research Program, told NBC News that the military is "leaving no stone unturned" in its hunt to find evidence-based treatments for depression and suicide. Included in its multimillion dollar research portfolio is a grant to evaluate whether a nasal spray using a fast-acting hormone could alleviate symptoms of both depression and suicidal behavior.

Related: Mental health disorders among troops increased 65 percent since 2000

The $2.9 million grant will support a three-year development and testing period that will ideally culminate in seeking Food and Drug Administration approval for the medication and delivery device. The grant was awarded in April to Dr. Michael Kubek, a professor of neurobiology at Indiana University. 

Kubek will research the use of Thyrotropin-Releasing hormone (TRH), which is known to act rapidly in relieving depression and suicidal behavior. However, its effects are short-term and the hormone has difficulty crossing the blood-brain barrier. Kubek is aiming to load up nanoparticles with TRH and then deliver them via the nasal spray, which could lengthen the drug's effectiveness and overcome the challenges of getting past the blood-brain barrier.

The military is hopeful that the spray will provide a treatment for the period between when a patient is first diagnosed for depression or suicidal thoughts and when typical anti-depressants become fully effective, which can take three to six weeks.

The clinical trial will compare a few hundred patients split into two groups: one receiving the nasal spray and another getting a similar drug used to treat suicidal behavior and depression. The idea, Castro said, is to determine not only if the spray works, but if it is more effective than current drug therapies. The study will look at whether or not the drug decreases depression and suicidal thoughts.

Should the drug prove effective, Castro said a realistic timeline for putting it in a soldier's hands would be five to eight years to account for possible setbacks and additional studies.

The research is part of a $100 million  effort to study psychological and mental illness in the Army. Half of that funding is for Army STARRS (Study To Assess Risk and Resilience in Servicemembers), an initiative done in partnership with the National Institute of Mental Health to gather details about the lives and mental health of 55,000 soldiers. The Army hopes that the epidemiological study may eventually identify groups of soldiers whose mental health is most fragile based on an algorithm or formula of factors.

Related: Army program aims to predict soldiers' resiliency

The Army has allocated $18 million for 12 studies looking at treatment for depression and suicidal thoughts. The nasal spray study is the only one in the Army's portfolio to test a drug. 

Despite the fact that suicide ranks in the top 10 leading causes of death in the U.S. — 36,909 people died by suicide in 2009 according to the latest available figures — clinicians still don't have a set of evidence-based standards for how to effectively treat suicidal patients. Instead, they rely often on a combination of medication and therapy that has shown promise, but has varying degrees of success.

The urgency to find a treatment has become critically important to the military as it searches for answers to its own suicide epidemic.

"We have no real explanation for why they're happening," Castro said of military suicides. The goal, he said, is to base treatment on science as opposed to "medical hunches."

The time it takes to design and execute a study can be frustrating to those waiting for an effective treatment, but Castro said, "at least at the end of the day, we'll know if something does work."

Rebecca Ruiz is a reporter at NBC News and a 2011-2012 Rosalynn Carter Mental Health Journalism Fellow. Follow her on Twitter here.

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There were 38 suspected suicides among active-duty and reserve soldiers in July, according to data released Thursday by the U.S. Army.

That figure outpaces the 24 active-duty and reserve suicides the Army reported for the month of June and is the highest monthly number of suicides since record-keeping began a few years ago.  

The Department of Defense did not attempt to explain the abrupt surge in suicides for the month of July in a statement announcing the figures.

"I do believe suicide is preventable," Gen. Lloyd J. Austin III, vice chief of staff of the Army, said in the release. "To combat it effectively will require sophisticated solutions aimed at helping individuals to build resiliency and strengthen their life coping skills."  

Related: Survivors of military suicide victims come together to grieve

Bruce Shahbaz, a medical analyst on the Army’s Suicide Prevention Task Force, told Time that experts did notice the deaths of non-commissioned officers outnumbered those of junior enlisted members for the first time since 2001. NCOs are more likely to be older, married and at home between deployments, a period of time that can be turbulent and exacerbate stress, according to Shahbaz.

"Issues like minor depression, anxiety and sleep disturbances -- those things that are kind of related to post-traumatic stress -- begin to surface after a service member has been home for more than a year, and start to reintegrate with their family … I liken it to a pot that’s on simmer -- having that person stay back home and reintegrate with their family sometimes allows that pot to boil over," Shahbaz told Time.

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The Tragedy Assistance Program for Survivors (TAPS), a non-profit organization that provides counseling resources to suicide survivors, estimates that each death personally impacts 10 people. TAPS said that each week, eight to 10 people grieving for a service member who died by suicide seek its services.

"We are deeply saddened by these numbers, and renew our commitment to support the families left behind who are grieving the death of soldiers by suicide," the organization said in a statement.

So far in 2012, the Army has confirmed 66 active-duty suicides and continues to investigate 50 more, for a total of 116 cases. There were 165 confirmed active-duty suicides in 2011.

Rebecca Ruiz is a reporter at NBC News. Follow her on Twitter here.

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